Ulnar fracture

　　There are many causes of ulnar fracture

　　1. Impact force: Often caused by a blow injury, the fracture is mostly transverse or comminuted, and the fracture lines of the two bones are often at the same horizontal level.

　　2. Transmission force: When the palm of the hand touches the ground during a fall, the force produced causes a fracture.

　　3. Twisting force: When the transmission force occurs, the forearm may also be subjected to a twisting force. The fractures caused by this excessive twisting are often spiral, and the horizontal plane of the fracture line of the two bones is different, with the fracture line of the ulna on the top and the fracture line of the radius on the bottom.

　　The diseases that may be accompanied by ulnar fracture are as follows;

　　1. Non-union of fractures is rare, with an incidence rate not exceeding 5%. It is often due to the gap at the fracture end, causing fibrous healing. If the gap is small, there is a strong and thick fibrous tissue in the gap;

　　2. Functional disorders of the elbow joint are rare. If the gap is large, there is a thin and long fibrous tissue that is easy to be stretched in the gap, which is more likely to cause the function of extension of the elbow joint to decrease, and even a slight violent force can cause the fibrous healing site to break.

　　When the fracture does not heal and is accompanied by severe pain or limited flexion and extension of the elbow joint, surgical treatment should be considered. For young patients, internal fixation and bone grafting can be used, and attention should be paid to removing the ossified surface of the fracture end during the operation. According to the specific situation, decide whether to use a bone graft block to fill the defect, and whether to use tension band wire fixation or plate fixation. Regardless of the type of fixation method adopted, when applying axial pressure during the operation, attention should be paid to prevent the distance between the coronoid process and the olecranon process from shortening.

　　3. According to Eriksson et al. (1957) reported, up to 50% of patients have restricted activity, especially extension limitation of the elbow, but it is not common in the cases reported by him, only 3%. Restricted activity is often not severe, has little impact on daily function, and is often not noticed by patients. It may be related to improper functional exercise and the tail of the needle in the fixation pin stimulating the dorsal side of the distal humerus, generally no special treatment is required. 10% of patients may have ulnar nerve symptoms, including numbness, decreased sensation, etc., but most can recover spontaneously, no special treatment is needed.

　　Non-displaced ulnar fractures are manifested as swelling and tenderness. Displaced ulnar fractures and those with associated dislocations have a wider range of swelling. A depression, fracture fragments, and crepitus can be felt behind the elbow. The function of the elbow joint is lost.

　　Ulnar fractures are mostly caused by direct violence. They are often seen in sudden attacks of external force, such as when a patient raises their hand to block the head and face and is struck directly by a stick. Prevention should include avoiding external force injuries to the forearm.

　　Ulnar fractures are often caused by transmitted violence, such as when the palm of the hand touches the ground during a fall. Or because of the excessive twisting caused by the simultaneous occurrence of twisting external force, the fracture line is often spiral-shaped. Prevention should include reducing falls and avoiding hand support that may lead to ulnar fractures.

　　The auxiliary examination for ulnar fractures mainly includes X-ray examination: when evaluating the olecranon fracture, one of the most common mistakes is not obtaining a true elbow lateral X-ray film. In the emergency room, it is often obtained that a slightly inclined lateral X-ray film, which cannot fully determine the accurate length of the fracture line, the degree of fracture fragmentation, the range of joint surface tear at the semilunar notch, and any displacement of the radius head. It is recommended to obtain a true elbow lateral X-ray film as much as possible to accurately grasp the characteristics of the fracture. The anteroposterior X-ray film is also very important, as it can show the direction of the fracture line in the sagittal plane. If the radius head also fractures at the same time, a significant shortening along the fracture line can be observed on the lateral X-ray film, and there is no angular or displacement. If necessary, take contrast X-ray films of both sides.

　　Whether nutrients are adequately and correctly supplemented is related to the recovery and prognosis of patients with ulnar fractures. Which foods are suitable and which should be avoided? The following is a brief introduction.

　　Appropriate Diet

　　1. It is recommended to eat more foods rich in protein and calcium, such as ribs, tendons, shrimp shells, egg products, dairy products, fish, and shellfish.

　　2. It is advisable to eat more fresh vegetables and fruits, such as amaranth, coriander, celery, tangerines, walnuts, apples, and so on. These not only supplement vitamins but also ensure that the nourishment is not retained in the body.

　　3. It is recommended to eat more foods rich in vitamin A and D, such as animal liver, dairy products, fish liver oil, egg yolks, and carrots.

　　4. It is advisable to supplement more foods rich in phosphorus to ensure the calcium-phosphorus ratio in the body. Foods with high phosphorus content include liver, pork, fish, and chicken.

　　5. It is recommended to eat more foods rich in trace elements such as iron, zinc, and copper, which are beneficial for the repair of fractures, such as shellfish, meats, and grains.

　　6. Fractures are always accompanied by muscle injuries. During the late stage of fractures, it is recommended to eat more kidney-nourishing and muscle-strengthening foods, such as walnuts, chestnuts, shrimps, goji berries, beef, and so on.

　　7. It is advisable to consume foods that benefit the liver and nourish the blood, such as pork liver, jujube, chicken, goji berries, grapes, lichee, and so on.

　　Taboo Foods

　　1. Avoid spicy and irritating as well as warm and dry foods such as chili, curry, and lamb.

　　2. Avoid cold and cool foods such as cold drinks and unripe pears.

　　3. Avoid acidic foods such as plum vinegar and white vinegar, as acidity is not conducive to the dispersion of blood stasis.

　　4. Avoid excessive consumption of sugar, as excessive sugar metabolism can easily cause acidosis in the body, excessive consumption of calcium, magnesium, sodium, and other ions, which is not conducive to fracture repair. In addition, the metabolism of sugar consumes a large amount of vitamin B1, which in turn affects the recovery of nerve and muscle function.

　　5. Avoid greasy and hard-to-digest foods such as fried foods, sweet potatoes, and glutinous rice.

　　6. Avoid刺激性 drinks such as coffee, strong tea, and strong liquor.

　　7. Avoid insufficient water intake, as insufficient water intake can easily lead to constipation, urinary retention, urinary tract infection, and other conditions.

　　The treatment results of any ulnar fracture treatment should achieve strong and stable extension of the elbow, good flexion and extension range, and excellent joint surface fit. Common treatment methods are as follows.

　　1. Functional Position Immobilization

　　For various types of fractures without displacement, the elbow or semi-extended elbow position is fixed with plaster for 3 weeks, and then the elbow joint movement is started after the immobilization is removed.

　　2. Open Reduction and Internal Fixation

　　For displaced transverse or oblique fractures, open reduction should be adopted as much as possible. There are various internal fixation methods, which are selected according to the type of fracture. Common fixation methods include cancellous bone screws or bicortical bone screws. Due to satisfactory reduction and firm fixation, elbow joint movement can be practiced within 1-2 weeks after surgery. Hook-shaped steel plates or tension band steel wire '8'字suture fixation is suitable for comminuted fractures and can avoid early activity after external fixation.

　　3. Excision of Fracture Pieces and Triceps Tendon Formation

　　For severe comminuted fractures, where the coronoid process and the distal end of the semilunar notch are intact, excision of bone fragments can be performed, but a layer of cortical bone should be retained at the insertion of the triceps tendon to facilitate suture of the distal断面. If a layer of cortical bone cannot be retained, the triceps tendon can be flipped down and fixed into the distal drilled hole.

　　For those who undergo open reduction or excision of bone fragments, they are generally fixed in extension of the elbow, and the time should be short, about 3-4 weeks to remove the external fixation, and start active exercises of elbow flexion and extension.